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7/25/2019 A.6 Evidence Based Practice PowerPoint 2015
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John Hamilton &
Fsun uhadarolu-etinDEPRESSION IN CHIDREN !ND
!DOESCEN"S
Introdu#tion
E$iden#e-%ased
Pra#ti#e in
Child and!doles#ent
ental
Health
!da'ted () Henri*+e ,lasen
Cha'ter !.
Com'anion Po/er'oint
Presentation
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"he 0I!C!P!P "e1t(oo* o2 Child and !doles#ent ental Health3 isa$aila(le at the I!C!P!P /e(site htt'566ia#a'a'or76ia#a'a'-te1t(oo*-o2-#hild-and-adoles#ent-mental-health
Please note that this (oo* and its #om'anion 'o/er'oint are58 Free and no re7istration is re9uired to read or do/nload it8 "his is an o'en-a##ess 'u(li#ation under the Creati$e Commons!ttri(ution Non- #ommer#ial i#ense !##ordin7 to this: use:distri(ution and re'rodu#tion in an) medium are allo/ed /ithout'rior 'ermission 'ro$ided the ori7inal /or* is 'ro'erl) #ited and theuse is non-#ommer#ial
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;
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Random errors are due to un*no/nand6or un'redi#ta(le #han7es in
measurin7 instrument oren$ironment Diminished () lar7er sam'le sies
%ias As)stemati# errorB areina##ura#ies that are #onsistentl) inthe same dire#tion !n e$er 'resent ris*
Evidence-Based Practice
Statisti#al Con#e'ts"he (i77est enemies o2 truth5 random error
and (ias
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Evidence-Based Practice
Statisti#al Con#e'ts"he (i77est enemies o2 truth5 random error
and (ias
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Mean ():
the most #ommon$alue in a normal
distri(ution Standard
deviation (SDB5
measures $aria(ilit)
Efect size:standardied
dieren#e (et/een
7rou's
Evidence-Based Practice
Statisti#al Con#e'ts! 2e/ use2ul (asi# #on#e'ts AiB
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Absolte ris! redction (A""): ho/ mu#hdoes one treatment redu#e the ris* o2 a (ad out#ome#om'ared to an alternati$e Atreatment or 'la#e(oB
#on$dence %nterval (#%): an indi#ation o2 the're#ision6im're#ision o2 the stud) sam'le as anestimate o2 the true 'o'ulation $alue
&'ber needed to treat (&&):num(er o2
'eo'le /e must treat to 're$ent oneadditional (adout#ome
&'ber needed to ar' (&&*):9uantiGesthe ris* o2 harm2ul side ee#ts
Evidence-Based Practice
Statisti#al Con#e'ts! 2e/ use2ul (asi# #on#e'ts AiiB
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!2ter ;= /ee*s on the "!DS stud) .@ o2'atients on 'la#e(o /ere not im'ro$ed#om'ared to > o2 'atients on uo1etine
+at is te A"", +at is te &&,
In the same stud) ;= o2 those treated /ithuo1etine re'orted some harm-related
e$ent: #om'ared to @ o2 those on 'la#e(o +at is te &&*,
+old o se tis treat'ent,
Evidence-Based Practice
Statisti#al Con#e'tsKot thatL E1am'les5
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Child6!doles#ent!n1iet) ultimodalStud) AC!SB
Com'arin75- Pla#e(o
- C%" alone
- Sertraline alone
-
C%" M SertralineKra'h sho/s s#ores2or P!RS APediatri#!n1iet) Ratin7 S#aleB
- Note error (ars
Evidence-Based Practice
Statisti#al Con#e'ts
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Ee#t sie A(ased on im'ro$ements in P!RSB5 C%" alone5 >; Asmall6medium ee#tB
Sertraline alone5 ?@ Amedium ee#tB Com(ination5 . Alar7e ee#tB
NN"5 (ased on im'ro$ement A$er) mu#him'ro$edB
C%" alone > Sertraline alone >
Com(ination5 = Athat is lo/ en#oura7in7B
Evidence-Based Practice
Statisti#al Con#e'ts
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"o ma*e 7ood use o2 E%: dia7noses need to (eali7ned (et/een resear#h and 'ra#ti#e
"eliabilit: #onsisten#) o2 a measurin7
instrument a#ross time: indi$iduals and #lini#ians"est-retest relia(ilit)
Inter-rater relia(ilit)
.alidit: the e1tent () /hi#h a dia7nosti#
instrument measures /hat it #laims to measure O2ten measured indire#tl): 'redi#tion o2 #ourse:
out#ome
Correlation #oe#ients: 2a#tor loadin7 #an 9uanti2)
Evidence-Based Practice
! $alid and relia(le dia7nosis"he 2oundation o2 e$iden#e (ased medi#ine
AE%B
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&/ B/ Most instr'ents ave onl been tested in te0S and Ero1e
Evidence-Based Practice
! $alid and relia(le dia7nosis"he 2oundation o2 e$iden#e (ased medi#ine
AE%B
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S#reenin7 9uestions and homin7 in5 E7: semi-stru#tured inter$ie/s su#h as ,-S!DS
Inter$ie/ers do not ha$e to as* ea#h 9uestion I2 'ro(in7 9uestions are ans/ered ne7ati$el) the rest
o2 the se#tion #an (e s*i''ed
Clear thresholds 2or /hen to #ount a s)m'tom as'resent or a(sent and /hen to home in Ae7: =
al#oholi# drin*s 'er /ee* 2or 'ast ? /ee*sB
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Evidence-Based Practice
Choosin7 a treatment"he ')ramid o2 e$iden#e
Evidence Based Practice
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Remain #urious /hen doin7 #lini#al /or*
!s* 9uestions rele$ant to the 'atients )ou see
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Terry is 10 years old and has ADHD-I (inattentive
type). He was helped by methylphenidate 1mg
three times!day" but lost a lot o# weight.$timulants and atomo%etine both suppress
appetite. &uan#a'ine is nown to help ADHD
'ombined type" but is it also ee'tive #or ADHD-
I* Qhat is the e$iden#e that Kuan2a#ine is
ee#ti$e in a ; )ear old /ith !DHD-IL
I2 ee#ti$e: /hat is the ee#t sieL
Evidence-Based Practice
Sear#h data(asesele#troni#all)
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%e7in /ith Pu(ed Cli#* on 0!d$an#ed3: sele#t 0!DHD3
2rom the eSH terms: then 0sear#h3
"here are too man) hits o$er ;.
No/ re'eat the 're$ious ste's 2or 07uan2a#ine3 0!ND3 and
0! FIEDS3: then 0sear#h3 A? hitsB
Cli#* 0imits3 and sele#t 0meta-anal)sis3 A= hitsB: (ut (oth
do not a''l) to )our 'atient
Chan7e )our limits to 0RC"3 A hitsB: = o2 them a''li#a(leto a ; )ear old /ith !DHD /ithout ti#s
; arti#le is 2ree: (ut 2unded () 'harma#euti#al #om'anies
A'ossi(le (iasLB and #on#erns e1tended release 7uan2a#ine
Sear#h data(asesele#troni#all)
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Hal2 li2e 7uan2a#ine5 ;>-;? hours: so t/i#e-dail)
dose mi7ht mimi# e1tended release 2orm
Ee#t sieL De'endin7 on dose (et/een @ and
;>? 2or !DHDtotal s#ores
!nd 2or inattention s'e#iG#all)L
No ee#t sie 7i$en: (ut redu#tions in a(solute
s#ores on a ratin7 s#ale are (i77er 2or inattentionthan 2or h)'era#ti$it)
Result5 It is reasona(le to #on#lude that a ; )ear
old /ith !DHD-I ma) si7niG#antl) im'ro$e /ith
7uan2a#ine at a dose o2 ;-=m7 t/i#e6da)
Evidence-Based Practice
Sear#h data(asesele#troni#all)
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a!e o'e 'essage5
+eep sear'h strategies transparentand 'lear and always monitor how
many hits result, these data allow
you to be 'ontinually adusting yoursear'h to your purposes" time and
interest.
Evidence-Based Practice
Sear#h data(asesele#troni#all)
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Qhat is the e$iden#e thatU P - ! s'e#iG#patientor problem
% - treated /ith a s'e#iG# intervention
# - )ields in comparisonto alternati$e treatment
2 - /hat outcome*
Sear#h 2or ans/er usin7 PICO 9uestions
Criti#all) a''raise the e$iden#e 2ound Inte7rate /ith #lini#al e1'ertise and 'atient
$alues
E$aluate the results
Evidence-Based Practice
Classi# E% and 0the ans/era(le9uestion3
Findin7 the (est treatment 2or )our 'atient
Evidence-Based
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Che#* ea#h
ste' o2 a'a'er 2or itsstandard
Evidence-BasedPractice
Classi# E%and 0the
ans/era(le9uestion3Findin7 the
(est treatment2or )our 'atient
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%elie2s and $alues